In the prior art, it is known to utilize an inserter device for the purpose of installing an absorbant tampon in the internal vaginal cavity. For example, U.S. Pat. No. 3,857,395 discloses an inserter device which includes a pair of outwardly bendable arms which bilaterally spread the tampon within the vaginal cavity.
In addition, other types of instruments are known in the prior art for manipulating internal body tissue. For example, U.S. Pat. No. 4,909,789 discloses observation assisting forceps including a set of expandable wires mounted on a shaft which is normally retracted into a sheath. When the shaft is advanced, the wires project out of the sheath and expand into a fan-shaped configuration in the same plane. The expanded wires can be used to set aside internal organs obstructing the observation with an abdominal cavity endoscope. The wires are provided at the tips with spherical members which prevent the organs from being hurt.
U.S. Pat. No. 4,654,028 discloses an incision opening expansion holder including a plurality of wires at the end of an inner tube which are three dimensionally expanded when projecting out of an outer tube to expand an incision of a blood vessel graft for purposes of inosculation. U.S. Pat. No. 4,705,041 discloses a tissue dilator comprising a catheter which supports an expandable member, e.g., a balloon or a scissor-like member. U.S. Pat. No. 1,878,671 discloses a dilator for opening a body cavity including an ovate head mounted on a wire received in a tube which is inserted into the body cavity. U.S. Pat. No. 4,655,219 discloses a tissue grasping accessory including a plurality of flexible grasping arms for use with an endoscopic instrument to grasp a tissue specimen. U.S. Pat. No. 4,590,938 discloses a device for removal of kidney stones through the working channel of an endoscope including a basket comprising four outwardly bowed, generally flat spring arms which are expandable into a bulbous shape and collapsed when retracted into a sheath. The relatively broad, flat surfaces of the spring strips deflect the kidney tissue surrounding the stone while the distally enlarged volume of the basket allows the surgeon to dislodge and capture the stone.
Co-pending U.S. patent application Ser. No. 779,432, filed Oct. 18, 1991, entitled "Adhesion Barrier Applicator", assigned to the same assignee as the present invention, discloses an applicator for applying a sheet of surgical material, e.g., an absorbable adhesion barrier, to internal body tissue to reduce the incidence of post-operative adhesions. The applicator is insertable into a trocar or endoscopic tube through an incision in a body wall to enable a surgeon to apply the adhesion barrier to tissue inside the body. The applicator includes a set of telescoping tubes comprising an outer delivery tube, an intermediate deployment tube, and an inner irrigation tube. An expandable spreader tip is mounted at the distal end of the irrigation tube and connected to the distal end of the deployment tube. By advancing the deployment tube and irrigation tube relative to the delivery tube, the expandable spreader tip is exposed at the distal end of the delivery tube. The spreader tip is expanded by movement of the deployment tube relative to the irrigation tube to spread the adhesion barrier over the tissue. A nozzle is provided at the distal end of the irrigation tube for applying a saline solution to the adhesion barrier.
The adhesion barrier applicator of U.S. patent application Ser. No. 779,432 is advantageously employed in performing gynecologic-pelvic surgery to apply an adhesion barrier to internal body tissue. The adhesion barrier is applied at the surgical site to the traumatized tissue surfaces after hemostasis to physically separate opposing tissue surfaces during the period of repair or reperitonealization of the tissue. The adhesion barrier applicator is particularly suitable for applying an adhesion barrier of relatively small size to the internal body tissue. The adhesion barrier applicator employs a single stroke actuator mechanism to expose the spreader tip at the distal end of the delivery tube and expand the spreader tip to spread the adhesion barrier over the tissue. During the one-stroke operation of the acutator mechanism, the spreader tip cannot be repositioned on the tissue until the expansion of the spreader tip is completed. Thus, prior to the actuation of the adhesion barrier applicator, the spreader tip must be accurately aligned with the surgical site. Once the operation of the actuator mechanism is initiated, it is difficult to adjust the position of the spreader tip on the tissue. Also, the spreader tip of the adhesion barrier applicator does not incorporate any grasping features to enhance the ability of the spreader tip to adjust the position of the adhesion barrier on the tissue. Further, in the operation of the adhesion barrier applicator, the deployment tube cannot be rotated about its axis relative to the delivery tube to adjust the angular orientation of the spreader tip and the adhesion barrier.
Accordingly, it is an object of the present invention to provide an applicator which is adapted to precisely control the placement of a sheet of surgical material such as a surgical mesh to internal body tissue.
Another object of the invention is to provide an applicator to facilitate the installation of a sheet of surgical material such as a surgical mesh through an endoscopic tube to tissue in a body cavity.
It is also an object of the invention to provide a surgical mesh applicator which is suitable for insertion through an endoscopic tube and is adapted to spread the surgical mesh over a tissue application area to minimize the need for manipulation of the surgical mesh by separate grasping instruments.
A further object of the invention is to provide a surgical mesh applicator including an expandable spreader tip which is rotatable when retracted into the delivery tube and when exposed from the delivery tube to allow the angular orientation of the surgical mesh to be adjusted.
It is a further object of the invention to provide a surgical mesh applicator including an expandable spreader tip which is adapted to grip the surgical mesh to facilitate the placement of the surgical mesh in a desired position on the tissue.